EPA's Report on the Environment: External Review Draft
Health StatusWhat are the trends in health status in the United States?
Importance of Trends in Health Status
For example, at the beginning of the 20th century, the U.S. population was characterized by a low standard of living, poor hygiene, and poor nutrition; communicable diseases and acute conditions were major causes of most premature deaths. Over the course of the century, public health measures such as improved sanitation and drinking water treatment led to a dramatic decrease in deaths due to infectious diseases and a marked increase in life expectancy. As the population has aged, chronic diseases such as heart disease and cancer have become the leading causes of death.2 These diseases may require a different approach to prevention, detection, and treatment compared to the infectious and acute illnesses more common in the past.
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Measures of Health Status
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While no single set of measures can completely characterize the health of a large and diverse population, the Centers for Disease Control and Prevention (CDC) and other health agencies worldwide consistently have viewed life expectancy and mortality data as indicators of overall population health because they represent the cumulative effects of social and physical environmental factors, behavioral and genetic risk factors, and the level and quality of health care. These data include the leading causes of mortality (among both infants and the general population), and thus provide a broad perspective on the diseases and conditions that are having the greatest impact on the nation's health. Infant mortality is a particularly useful measure of health status, because it:
- General mortality represents the number of all deaths nationwide and provides information on the leading causes of death. Mortality is also tracked using years of potential life lost, or the number of years “lost” by people in a population who die prematurely of a stated cause.
- Infant mortality is the number of infants who die before their first birthday.
- Life expectancy is the average number of years a newborn would be expected to live if current death rates were to remain constant.
These indicators (which all rely on data from CDC's National Center for Health Statistics are interrelated. For example:
- Declines in mortality result in increased life expectancy.
- Shifts in life expectancy are often used to describe changes in mortality.
- Changes in infant mortality are reflected in general mortality as well.
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The three ROE health status indicators can be compared with data from the World Health Organization (WHO), which calculates health statistics for its 193 member states/countries. (Note that the WHO uses an approach that ensures comparability across data sets; its statistics may not fully match those generated by individual countries and reported in other reports.)
- Life expectancy: In 2009, 28 of the 193 WHO member states reported longer life expectancies at birth than in the United States for both males and females combined.5 Japan and San Marino report the highest life expectancy at 83 years, compared to the U.S. life expectancy of 79 years.6
- Leading causes of death: The top five leading causes of death reported in the United States in 2008 and 2009 were heart disease, cancer (malignant neoplasms), chronic lower respiratory diseases, stroke (cerebrovascular), and accidents (unintentional injuries) (General Mortality indicator). The most recent worldwide data (2008) show that cardiovascular diseases (i.e., coronary heart disease and stroke) accounted for the largest percentage of deaths (23.6 percent). Lower respiratory infections (6.1 percent), chronic obstructive pulmonary disease (5.8 percent), and diarrheal diseases (4.3 percent) are also among the top five causes of death reported worldwide. HIV/AIDS is ranked as the sixth leading cause of death worldwide (3.1 percent of all deaths). Cancer deaths are listed by site, with trachea, bronchus, and lung cancer ranked as the seventh leading cause of death worldwide.7
- Infant mortality: In 2010, 43 of the 193 WHO member states reported lower infant mortality rates than the United States. For example, eight WHO member states (Iceland, Japan, Singapore, Sweden, Finland, Luxembourg, Slovenia, and San Marino) have infant mortality rates of two deaths per 1,000 live births, compared to the U.S. infant mortality rate of seven infant deaths per 1,000 live births.8
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- While environmental contaminants can influence public health, so can many other factors, including socio-demographic attributes, behavioral and genetic risk factors, level of preventive care, and quality of and access to health care. Therefore, the health status indicators presented here are broad, are not intended to represent specific diseases or conditions related to the environment, and cannot alone be used to draw conclusions about how exposure to environmental contaminants influences public health. They do, however, provide important context for indicators of trends in human disease and conditions for which environmental contaminants may be a risk factor.
- While declining mortality rates and increasing life expectancy suggest improving health status, these indicators do not address other aspects of health, such as morbidity, perceived well-being, or quality of life, for which data are not available on a national scale.
- Improved data (including standardized data collection) on the health status of population subgroups—particularly across race and ethnic groups—would allow better characterization of potential trends across different groups for the three indicators presented.
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